Occupational Asthma Reference

Migueres N, Debaille C, Walusiak-Skorupa J, Lipinska-Ojrzanowska A, Munoz X, van Kampen V, Suojalehto H, Suuronen K, Seed M, Lee S, Rifflart C, Godet J, de Blay F, Vandenplas O, Occupational asthma caused by quaternary ammonium compounds: A multicenter cohort study., J Allergy Clin Immunol Pract., 2021;:,https://doi.org/10.1016/j.jaip.2021.04.041

Keywords: OA, benzalkonium chloride, quarternary ammonium, ERS, sputom eosinophils, NSBR,

Known Authors

Olivier Vandenplas, Universite Mont-Goginne, Yvoir Olivier Vandenplas

Martin Seed, Manchester University Martin Seed

Xavier Munoz, Barcelona Xavier Munoz

Hille Suojalehto, Finnish Institute of Occupational Health Hille Suojalehto

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Abstract

BACKGROUND:
Quaternary ammonium compounds (QACs) are used extensively for cleaning and disinfection and have been documented in scattered reports as a cause of occupational asthma (OA) through bronchoprovocation tests (BPT).

OBJECTIVE:
To examine the clinical, functional, and inflammatory profile of QAC-induced OA compared to OA caused by other low-molecular-weight (LMW) agents.

METHODS:
The study was conducted in a retrospective multicenter cohort of 871 subjects with OA ascertained by a positive BPT. Subjects with QAC-induced OA (n=22) were identified based on a positive BPT to QACs, after exclusion of those challenged with cleaning products or disinfectants that contained other potential respiratory sensitizers, and they were compared to 289 subjects with OA caused by other LMW agents.

RESULTS:
Most subjects with QAC-induced OA were working in the healthcare sector (n=14). A =2-fold increase in the postchallenge level of nonspecific bronchial hyperresponsiveness was recorded in 8 of 11 (72.7%) subjects with QAC-induced OA, and in 49.7% of those with OA due to other LMW agents. Although sputum assessment was available in only 8 subjects with QAC-induced OA, they showed a significantly greater median (interquartile) increase in sputum eosinophils (18.1% [12.1 to 21.1]) compared to those with OA due to other LMW agents (2.0% [0 to 5.2], P< 0.001).

CONCLUSION:
This study indicates that QAC-induced OA is associated with a highly eosinophilic pattern of airway response and provides further evidence supporting the sensitizing potential of QACs. The findings highlight the heterogeneous nature of the pathobiological pathways involved in OA caused by LMW agents.

Plain text: BACKGROUND: Quaternary ammonium compounds (QACs) are used extensively for cleaning and disinfection and have been documented in scattered reports as a cause of occupational asthma (OA) through bronchoprovocation tests (BPT). OBJECTIVE: To examine the clinical, functional, and inflammatory profile of QAC-induced OA compared to OA caused by other low-molecular-weight (LMW) agents. METHODS: The study was conducted in a retrospective multicenter cohort of 871 subjects with OA ascertained by a positive BPT. Subjects with QAC-induced OA (n=22) were identified based on a positive BPT to QACs, after exclusion of those challenged with cleaning products or disinfectants that contained other potential respiratory sensitizers, and they were compared to 289 subjects with OA caused by other LMW agents. RESULTS: Most subjects with QAC-induced OA were working in the healthcare sector (n=14). A >=2-fold increase in the postchallenge level of nonspecific bronchial hyperresponsiveness was recorded in 8 of 11 (72.7%) subjects with QAC-induced OA, and in 49.7% of those with OA due to other LMW agents. Although sputum assessment was available in only 8 subjects with QAC-induced OA, they showed a significantly greater median (interquartile) increase in sputum eosinophils (18.1% [12.1 to 21.1]) compared to those with OA due to other LMW agents (2.0% [0 to 5.2], P< 0.001). CONCLUSION: This study indicates that QAC-induced OA is associated with a highly eosinophilic pattern of airway response and provides further evidence supporting the sensitizing potential of QACs. The findings highlight the heterogeneous nature of the pathobiological pathways involved in OA caused by LMW agents.

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